The relative efficacy of nine osteoporosis medications for reducing the rate of fractures in post-menopausal women

BMC Musculoskeletal Disorders

Research Article

Lehana Thabane¹  Eleanor Pullenayegum¹  Robert B Hopkins²  Feng Xie³  Ron Goeree³  Jonathan D Adachi⁴  Alexandra Papaioannou⁴ 

[1] Department of Clinical Epidemiology and Biostatistics, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada;Centre for Evaluation of Medicines, Hamilton, Ontario, Canada;Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada;Department of Clinical Epidemiology and Biostatistics, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada;Programs for Assessment of Technology in Health, St Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada;Department of Clinical Epidemiology and Biostatistics, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada;Programs for Assessment of Technology in Health, St Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada;Centre for Evaluation of Medicines, Hamilton, Ontario, Canada;Department of Medicine, McMaster University, Hamilton, Ontario, Canada;

关键词: Bone Mineral Density;    Vertebral Fracture;    Alendronate;    Zoledronic Acid;    Raloxifene;   

DOI  :  10.1186/1471-2474-12-209

 received in 2011-05-10, accepted in 2011-09-26,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundIn the absence of head-to-head trials, indirect comparisons of randomized placebo-controlled trials may provide a viable option to assess relative efficacy. The purpose was to estimate the relative efficacy of reduction of fractures in post-menopausal women, and to assess robustness of the results.MethodsA systematic literature review of multiple databases identified randomized placebo-controlled trials with nine drugs for post-menopausal women. Odds ratio and 95% credibility intervals for the rates of hip, non-vertebral, vertebral, and wrist fractures for each drug and between drugs were derived using a Bayesian approach. A drug was ranked as the most efficacious if it had the highest posterior odds ratio, or had the highest effect size.Results30 studies including 59,209 patients reported fracture rates for nine drugs: alendronate (6 studies), denosumab (1 study), etidronate (8 studies), ibandronate (4 studies), raloxifene (1 study), risedronate (7 studies), strontium (2 study), teriparatide (1 study), and zoledronic acid (1 study). The drugs with the highest probability of reducing non-vertebral fractures was etidronate and teriparatide while the drugs with the highest probability of reducing vertebral, hip or wrist fractures were teriparatide, zoledronic acid and denosumab. The drugs with the largest effect size for vertebral fractures were zoledronic acid, teriparatide and denosumab, while the drugs with the highest effect size for non-vertebral, hip or wrist fractures were alendronate or risedronate. Estimates were consistent between Bayesian and classical approaches.ConclusionTeriparatide, zoledronic acid and denosumab have the highest probabilities of being most efficacious for non-vertebral and vertebral fractures, and having the greatest effect sizes. The estimates from indirect comparisons were robust to differences in methodology.

【 授权许可】

CC BY   
© Hopkins et al; licensee BioMed Central Ltd. 2011